Sharing essential knowledge with health researchers and policy makers

Communities of practice

Global health research: the agenda broadens

12 Nov 2008

Nicole Biros and Paul Chinnock

Source: TropIKA

The 2008 Ministerial Forum on Research for Health, which is about to begin in Bamako (see TropIKA.net News), follows on from two earlier health research summits in Bangkok in 2000 and Mexico in 2004. The series of meetings was prompted by a recognition that the vast majority of health research spending globally had failed to address the problems faced by the majority of the world’s people. This has been summed up as the 10:90 gap – less than 10% of the expenditure is directed towards the needs of 90% of the global population.

However, a new report (also see TropIKA.net News) says that the needs of the poor are still not receiving sufficient attention. So, what is the impact of such big – and expensive – meetings, do they contribute to change, and how?

Change, as we know, often takes time, and the fact that these meetings could take place, focus interest on health and research and attract growing participation at global and regional levels is already quite an achievement. The global meetings have ensured continuity of purpose and communication for stakeholders. They also demonstrate the willingness to address the underlying issues and take a coherent, long-term perspective.

Close observers of the series of meetings believe that there has been progress. Continuity and gradual build up in the agendas of the three meetings have been encouraging. Over the years, the body of evidence required to inform discussion has grown. This evidence has fed into analyses and policy recommendations, and has enabled further planning, funding and the development of research. The meetings have also enhanced the visibility of research and health at policy level.

The range of stakeholders involved has increased and diversified since the 2000 meeting. It now includes: scientists, NGOs, UN agencies, development banks, governmental donors, focal points from local communities, private foundations and industry. Stakeholders, thanks to these meetings, have been able to share experience on a more regular basis and to at least consult on how to conduct their activities in a coordinated manner.

The more diverse audience that will be present in Bamako, in comparison to the earlier meetings, has had an impact on the agenda. The scope of the sessions has been adapted and enlarged while retaining the core research and health components. The list of topics to be discussed (see meeting agenda here) is impressive, ranging from the role of the private sector in health systems to transparency in clinical trials.

But the nature of a problem can alter while it is being discussed. It will be essential for the delegates to come to terms with the many changes that have taken place globally since the 2000 meeting and accelerated in recent years. As the world has changed, so have the issues around health inequalities. Delegates are faced with a moving target.

Climate change, population growth, the economic crisis and political changes in many countries (not least the USA) must all be factored into the debate. Some of the issues may need reformulation and new questions will need to be answered. Hopefully, the meeting is sufficiently flexible and responsive to allow this. The concern is that the addition of new issues does not slow down progress. Similarly, while the recognition of the need for intersectoral approaches is welcome, the risk would be to get bogged down in complex models or generalities. The real challenge will be to point to workable collaborative approaches. The needs are great. So will be expectations of the Forum.

In considering whether research expenditure is proportional to needs, the emphasis has for the most part been on disparities between rich and poor. Now, other questions are increasingly being asked. What proportion of research should be at the basic science level, or for product development, and how much should address the issues involved in the delivery of effective interventions on the front line of care? Genomic scientists and health systems researchers both make claims for their disciplines to be accorded a higher priority and to be given a larger slice of the funding cake. How is a balancing act to be achieved?

And which categories of diseases deserve most attention? The term ‘neglected diseases’ most often brings infectious conditions to mind but the rates of non-communicable disease in poor communities are rising. In the context of the developing world, diabetes and hypertension are also neglected. Injuries now account for 12-13 per cent of the entire global burden of disease but do not receive a proportionate level of attention in health research. A leading expert on the global burden of disease, Alan Lopez (1), has argued that, ‘...effort and resources devoted to communicable disease, however justified, will inevitably distract attention away from the massive, largely preventable health loss from injuries and non-communicable diseases.’ But those whose focus is on in the infectious diseases of poverty will point out that, for relatively modest expenditure, huge gains could be made in reducing morbidity and mortality from the infectious conditions that remain so common in the developing world.

What remains central to all discussions on health research is the need to find ways to provide effective care for all who need it – whether their treatment needs are for schistosomiasis or for diabetes – and to ensure healthy environments and lifestyles that will protect against a range of conditions. On the 30th anniversary of the Alma Ata Declaration, there have been calls for a return to the ideals of primary health care and participants in the Bamako meeting would do well to reflect on this.

Can a few days of discussion in an international conference centre solve all these issues? Of course not, but this key gathering in Mali will advance the debate and help set priorities. It will also serve to highlight the issues for a wider audience and publicise what has been achieved in recent years. The proportion of research that is devoted to health has increased at a remarkable rate and every effort must now be made to ensure that this expenditure is used to achieve maximum benefit. Bamako will play an important role in this process.

References

1. Lopez A (2008). Health and health-research priorities: has WHO got it right? Lancet; 372 (9649)1525-1527. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18984173